COFAS is funded by the Colorado Office of Behavioral Health.
We know that women who risk-drink, especially women who binge drink and drank heavily throughout the pregnancy are at risk for an alcohol exposed pregnancy and a diagnosis within Fetal Alcohol Spectrum Disorders (FASD). We also know from the research that early screening and intervention can decrease the incidence of an FASD diagnosis (Alaska, 2010). Research also shows that many health care providers lack the necessary skills and level of comfort to provide this needed screening.
Native aSBI & CHOICES (Denver Health/Denver Public Health)
Alcohol-Exposed Pregnancy (AEP) occurs when women drink alcohol during pregnancy. AEP can cause a range of birth defects, as well as neurodevelopmental and behavioral effects, collectively known as Fetal Alcohol Spectrum Disorders (FASD).1 Because excessive alcohol consumption is associated with other morbidity (in addition to FASD) and mortality, the U.S. Preventive Services Task Force (USPSTF) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) both recommend screening and behavioral counseling interventions for all patients in primary care settings.2-4 Brief intervention has been identified as an effective approach to reduce risky alcohol use by the USPSTF and the Agency for Healthcare Research and Quality (AHRQ).5-6 Brief intervention includes very brief intervention such as alcohol Screening and Brief Intervention (aSBI) and the extended brief intervention CHOICES.
Alcohol-Exposed Pregnancy (AEP) is a problem for women from all backgrounds, with national estimates that the most severe FASD, Fetal Alcohol Syndrome (FAS), occurs in 0.2 – 1.5/1000 births.7 Of reproductive age women responding to the Behavioral Risk Factor Surveillance Survey (BRFSS) in 2006 – 2010, 48.5% reported no alcohol use, 51.5% reported drinking at least one drink in the last 30 days, while 7.6% of pregnant women reported this. Binge drinking (> 4 drinks on one occasion in the last 30 days) was reported by 15% of nonpregnant women and 1.4% of pregnant women.8 National data indicate that approximately 49% of pregnancies are unintended, so the high rates of drinking alcohol (and especially of binge drinking) in reproductive age women increase the risk of an AEP.9
Alcohol Exposed Pregnancy’s (AEP) is a known problem within the American Indian population. Effective screening and brief intervention tools have been well validated for the general population, and work in American Indian populations indicates that these tools are likely effective in these groups as well. American Indians form a heterogeneous population, and interventions to reduce the risk of AEP will need to be adjusted to meet the needs of local populations.
The Mountain Plains FASD PIC (Mountain Plains) will serve medical assistants nationally through online trainings and regionally in the states of Colorado, Idaho, Montana, Nevada, North Dakota, South Dakota, Utah, and Wyoming by providing direct training and technical assistance. By working with national and state chapters of the American Association of Medical Assistants (AAMA), the Mountain Plains can address FASD prevention, identification, and treatment by developing, tailoring, and delivering discipline-specific curricula based on the CDC’s seven core FASD competencies for these professionals. Collaborations with these and other national/regional partners will afford the Mountain Plains an opportunity to leverage resources and expertise to create FASD curricula for medical assistants that include evidence-based strategies emphasizing the prevention of alcohol-exposed pregnancies and identification and treatment of individuals with an FASD. These curricula and products will be disseminated through multiple educational channels using web-based technologies, social media, and traditional professional development activities (e.g., workshops, booster sessions, and consultations), and evaluated to examine the impact on clinical practice change and sustainability of skills used to prevent, identify, and treat FASDs. Mountain Plains will also collaborate with other FASD PICs and National Partner grantees throughout Year 1 to accomplish identified project outcomes.
COFAS has identified measurable outcomes from its training of health and human service providers, designed to help them develop the skills to provide early intervention and head off possible FASD. Each training’s pre- and post-test was captures outcomes from the trained provider’s increased knowledge of screening tools, ability to identify the at-risk drinker as well as the alcohol-exposed individual, and how to refer these individuals for further assessment and/or treatment.
The new Colorado FASD “Train-the-Trainer Partnership to Prevent FASD” will have outcomes that are linked to trainers expanding FASD prevention within a community, including:
Short term outcomes
- Increased knowledge of alcohol consumption and negative impacts (i.e., FASD) among high-risk women of childbearing age
- Increased knowledge of diagnostic methods and screening tools
- Increased knowledge of the provider’s role and opportunities for early intervention and/or prevention
- Increased knowledge of referral assistance and support and appropriate referral base within community
- Increased community FASD prevention within all five AHEC regions
Intermediate term outcomes
- Increased use of diagnostic methods and screening tools
- Increased skill in identification, referral and brief intervention
- Improved attitudes by providers toward high-risk women actively participating in brief intervention
- Improved practice of engagement with high-risk women of childbearing age
- Improved FASD prevention in each of the five AHEC regions
Long term outcomes
- Improved overall care of alcohol-using/abusing women
- Increased prevention of future deterioration of alcohol-affected child